In many industries, reports are used to present, explain, or put into context various types of information including data, results of tests, information regarding procedures available or preferred, and the status of the project that may be the subject of the report. A report may include content in a variety of forms including static or dynamic images, text, and transcripts of verbal communications. For purposes of this application, this organized collection of content is termed a “report”.
In the medical industry, reports pertaining to the treatment and care of a patient are regularly generated. For purposes of this application, the term “medical report” refers to any documentation related to the treatment and care of a patient including, but not limited to test reports, procedural reports, surgical notes, or clinical notes. Medical reports may include a variety of forms of content, such as that described above. For example, the content may be text or static or dynamic images providing information regarding the patient's medical condition, such as the patient's history, symptoms, and diagnoses. The report content may also include information regarding medical procedures, including the details of the procedures to which the patient was subjected or offered, or the results of the procedures and the complications, if any, which the patient experienced. The content of a medical report may include also data directed to a current procedure which a patient is undergoing including measurements and lab reports. Additionally, the content within a medical report may include the observations, interpretations and recommendations of a treating physician, a consulting physician, or other caregiver. Medical reports are typically organized into sections, such as according to anatomy, pathology, and/or the content or subjects mentioned above. Medical reports may include additional information regarding the patient's insurance, family members, and orders and directions relevant to the patient's care.
Medical reports are usually created by a medical professional such as a doctor or nurse or other caregiver or agent such as a technician. Those that prepare a medical report are termed “medical professional” in this application. The medical professional preparing such a report often reviews results collected, information gathered, and other content on or relevant to a patient prior to creating the report—including lab reports, prior medical reports, and pre-study paperwork such as orders, patient-supplied datasheets, clinical notes, and electronic medical records (“EMRs”), as well as information from and notes taken of conversations directly with the patient or one or more of his or her family members.
Medical reports are prepared by one or more of a variety of methods, including handwriting, typing, dictation, speech recognition, and structured reporting. Dictation allows a medical professional to speak the substance of a report into a recording device. From this recording, a transcript is later prepared, often manually. The medical professional typically must review the transcribed report for accuracy. After the professional is satisfied with the accuracy of the transcript, a final report is prepared.
There are a variety of disadvantages associated with the traditional approaches to preparing a report. For example, with respect to transcriptions, because typically someone other than the author of the report actually prepares the transcript from the recording made by the professional, errors result from the transcriber's inability to accurately identify what the professional said. Spelling and grammatical errors often also appear in the transcript. In addition, it takes time for a dictated report to be transcribed, reviewed, edited, and approved for final distribution. This delay is undesirable and can further impact not only immediate patient care—particularly when the patient is in a critical condition—but also long term healthcare costs.
Speech recognition technologies are known. These technologies permit a user, such as a medical professional, to speak into a recording device and, through the use of speech recognition software, a transcription for the medical report can be prepared. For purposes of this application, speech recognition is defined to be synonymous with voice recognition. The transcription or report that results from this process can then be revised by the professional, either on a display device (real-time or off-line) or on paper (off-line), and edited, if necessary. This approach, however, is not problem-free.
Problems with conventional speech recognition technologies include erroneous transcription. Transcription error rates typically range from 5% to 15% depending on the speaker's skill with the language used to prepare the report, the environment, and vocabulary. Equally important, speech recognition errors are unpredictable, with even simple words and phrases being misrecognized as completely nonsensical words and phrases. In order to prevent these recognition errors from appearing in the final report, the medical professional must very carefully review the transcribed report. Given the large number of reports that many medical professionals are required to prepare in a single day, they often attempt to review the transcribed text as it is produced by speech recognition software by glancing at the transcribed text on the display device while receiving or analyzing the data or image about which the transcription or report is being prepared. In some reporting environments, however, this approach is time consuming and can cause errors in the transcribed text to be overlooked and/or cause errors to creep into the report. For radiologists, the traditional approach to report preparation using speech recognition software is particularly problematic. It is not easy for a radiologist to go from examining the intricate details of an X-ray to reviewing written words, then returning to examining the X-ray. The radiologist invariably loses the exact spot on the X-ray he or she was examining before reviewing the text transcribed from his or her dictated observations. In addition, the displayed report occupies space on the display device, preventing it from illustrating other content, such as images.
Structured reporting technologies are known also. They permit, for example, a medical professional to record information using a computer user interface, such as a mouse and/or keyboard. The medical report is automatically generated from this information in real-time. Structured reporting may also include the use of speech recognition software to support navigation, data entry, and editing such as adding text or images to the medical report.
The primary problem with structured reporting technologies is that it may take a medical professional what they may view as an unacceptable amount of time to complete a structured report using a traditional computer user interface. Medical reports often require very large structured reporting data sets. As a result, navigating these data sets may be complex and entering findings may become a lengthy process that requires time that medical professionals could use more effectively attending to other tasks, such as seeing additional patients, preparing additional medical reports, or reading medical literature.
Attempts have been made to improve the efficiency with which reports, including medical reports are prepared. Often these methods use what are termed “macros”. A “simple macro” is a text string identified by a name. For example, a macro corresponding to the text string “No focal liver mass or intrahepatic duct dilatation” may be identified by the macro name “Normal liver”. “Macro templates” are macros that include a mix of text strings and placeholders, such as blank slots or pick-lists. The placeholders indicate where the user may—or must—insert additional text. Some technologies that record and transcribe the spoken word utilize macros. For example, by mentioning the name of the macro in a voice command or a user interface, the associated text and placeholders are positioned in the medical report. The text can be edited and any placeholders filled in by the medical professional to generate narrative text.
Certain simple macros and the names by which each is identified are shown in the following chart. Each string of text (right column of chart) can be orally identified to the system that is being used to prepare the report by simply mentioning the name of the macro (left column of chart).
Macro NameText String“Right dominant”The coronary circulation is right dominant.“NormalThe     coronary arteries are patentcoronaries”without significant disease.“LAD lesion”The left anterior descending artery has a    stenosis in the     segment.
FIG. 1 illustrates how a portion of a CT angiography report can be prepared from these macros. More specifically, portion a) of FIG. 1 illustrates how the three macros above can be organized to form a portion of the entire report directed to the condition of a certain patient. Portion b) of FIG. 1 illustrates how the medical professional may fill in the placeholders in the text. Portion c) of FIG. 1 shows that an edit can be made to the first macro statement. The edit is shown in italics. An addition of a new statement is shown as a fourth sentence (also in italics).
Some systems allow reports to be generated through the use of an extensive set of macros or macro library. A macro library may include tens, hundreds, or even thousands of macros created, for example, by individual users to match a specific reporting style, or by commercial vendors and licensed as “comprehensive” macro sets. While large macro sets can be advantageous and permit a wide variety of reports to be prepared more rapidly under a wider range of circumstances, the sheer size of the library can be a disadvantage. Memorizing all of the macro names may be simply infeasible for the user. To lessen this problem, large macro libraries may include a user interface that categorizes macros and provides for visual navigation of the extensive macro library. However, this navigation approach has all of the disadvantages of a structured reporting user interface. Navigating an on-screen interface that categorizes the macros in the macro library takes significant time. It also requires a medical professional to remove his or her visual focus from other clinical activities, such as reviewing the medical images which are the subject of the report or even attending to a patient. Navigating an on-screen interface may be a significant distraction that may lead to errors, as well as increase the time it takes to prepare a report.
In addition, macros alone are usually insufficient to complete a medical report. Many medical reports consist of a combination of text strings recorded as macros (and perhaps subsequently edited) and unstructured free-form statements entered directly by the user (transcribed or typed).
Overall, dictation, speech recognition, and structured reporting (including structured reporting using traditional macros) constrain medical reporting, for example, with respect to speed and visual focus. Medical professionals need to create reports quickly and efficiently, and transmit the resulting reports rapidly to other medical professionals (e.g., referring physicians). Again, with respect to radiology, a single user may need to produce many, perhaps over a hundred reports in a single day. Preparing the report requires intense visual focus on one or more images, such as X-ray images, computed tomography (“CT”) scans, and ultrasound loops. Having to look away from an image to a computer user interface on which the text appears, is a significant time consuming distraction that again can lead to errors and longer reporting times.
As a result, there is a need for a reporting system that allows users, such as medical professionals, to create a report in an efficient manner while maintaining their visual focus on that subject about which the report is being written or on a subject or object different from that about which is the report is being prepared. More specifically, there is a need for a system that permits a user to receive information from a report aurally, thereby not requiring the user to distract his or her visual focus.